Healthcare Provider Details

I. General information

NPI: 1568671998
Provider Name (Legal Business Name): CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2500
US

IV. Provider business mailing address

1902 E AMBER LN APT 207
URBANA IL
61802-7104
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: JOHNATHON WOODS
Title or Position: REGISTERD NURSE
Credential:
Phone: 217-383-3088